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(1) Field of the Invention
The present invention relates generally to the field of contracture management orthotics, and more particularly to an improved two-piece orthotic device permitting more accurate casting of the extremity, and facilitating the simple, effective, and quick application of the device to a patient.
(2) Background Information
There are three general options available for splints for individuals with non-rigid contractures. First, over the counter (OTC) splints are available and are pre-sized from extra small through extra large, for left or right limbs. Second, a custom-made low temperature plastic splint is also currently utilized in the art, and is fabricated directly on the patient. Finally, a custom splint may be fabricated from a negative casting of the affected extremity.
Over the counter splints are economically manufactured because they are pre-sized. However, such splints do not typically fit the user very well without some modification or customization. This is typically accomplished by xe2x80x9cspot heatingxe2x80x9d the splint with a heat gun and then remolding the splint as necessary to conform to the patient""s extremity. The splint is then backfilled with padding. The finished product is most often not aesthetically pleasing. Depending upon the skill of the technician, the splint can also be uncomfortable because of the rough areas where modifications have been made to the splint.
Custom splints formed directly on patients are made of low temperature plastic and often share the same problems as the OTC splints. In addition, when forming the splint on a patient having a non-rigid contracture, it is necessary to hold the hand and wrist in a neutral or other predetermined position while such splints are being molded. This task can be very difficult since the patient is unable to assist in maintaining the predetermined orientation of the extremity. Moreover, low temperature plastic is a relatively soft material, and therefore does not hold up well over time.
Custom splints made from a negative casting of the patient""s affected extremity are known to be made using high temperature plastics. These are more rigid and durable than low temperature plastics and will usually last several years. While such custom splints have the potential of providing a durable product with the best possible fit, the practitioner must often struggle with the problem of casting across one or more joints affected by spasticity with high levels of tone. Trying to cast the extremity in a neutral or other predetermined alignment while struggling to hold the hand, wrist and forearm in this alignment, can be very difficult. Creating the necessary negative cast typically requires the use of two hands and a very tight grip just to align the patient""s extremities. Often, It can take several minutes to gradually obtain the desired position of the hand and wrist. If the extremities are released in order to wrap the casting material around the patient""s hand and wrist, the desired position is immediately lost. Repositioning the hand and wrist after applying the casting material distorts the negative cast. The distortion occurs because the casting material is stretched out of shape and thereby loses the desired xe2x80x9ctotal contactxe2x80x9d of the negative cast. The shape of the cast and therefore the resulting splint is also distorted by the practitioner""s grip in trying to regain control of the patients wrist and hand and place them into a neutral or other predetermined position.
In addition to providing a less than optimal fit, a common problem of all three prior art types of splints is in the donning of the splint by the patient. As mentioned above, it can take several minutes for a trained occupational therapist or orthotist to manipulate the hand and wrist of a patient with a very tight wrist flexion contracture into a neutral or predetermined position. The average care giver in a skilled nursing facility, rehab hospital, or other group home typically has neither the time, training nor skill required to properly apply a straight, rigid splint on such a contracture. Thus, many patients who could benefit from such a device either go without them, or are poorly positioned in the splint, and therefore do not receive the full benefit of the device.
Difficulties of prior art orthotic techniques and design are alleviated by utilizing the better fitting and more easily donned wrist splint disclosed within.
Therefore, it is a general object of the present invention to provide an improved two-piece wrist-hand-finger orthosis (WHFO) and method of casting the same.
Another object of the present invention is to provide a two-piece orthosis with a lever, to assist in donning the splint on the patient""s extremity.
A further object is to provide an improved casting technique for producing a nearly unresisted casting of the affected extremity.
These and other objects of the present invention will be apparent to those skilled in the art.
The two-piece wrist-hand-finger orthosis of the present invention includes a rigid forearm section secured to the patient""s arm, and a rigid hand section with a proximally projecting extension lever. The hand section is donned on the patient with the patient""s hand in flexion. The hand section is then leveraged into neutral by pivoting the extension lever downwardly into contact with the forearm section. The extension lever is then secured to the forearm section.